Fairness demands a hearing

Wednesday

Apr 9, 2014 at 3:15 AMApr 9, 2014 at 8:28 AM

Anthem Blue Cross Blue Shield has challenged the right of East Rochester resident Margaret McCarthy to be heard before she is forced to leave the health care sphere of Frisbie Memorial Hospital in Rochester.

McCarthy had been scheduled to go before a N.H. Insurance Commission hearing today in order to argue she should not be forced to lose the doctors and the hospital she now uses in order to qualify for coverage under the Affordable Care Act.

However, Anthem has challenged McCarthy’s standing in the case as untimely, arguing her challenge is too late, according to Department Enforcement Counsel Richard McCaffrey. As a result, today’s hearing has been put on hold.

Our hope and our urging is that Insurance Commissioner Roger Sevigny will decide her appeal is timely — and McCarthy’s case move forward.

Under the Affordable Care Act, McCarthy will be forced to sign up with Anthem’s new Pathways network of providers when her current policy expires in August. Since Frisbie has been excluded from the network by Anthem — with state approval — this means being forced to leave her current providers and travel to an in-network hospital.

So far Frisbie officials have unsuccessfully argued the N.H. Insurance Commission erred in approving Anthem’s Pathways network. In the case of Frisbie alone, the fate of 7,000 clients is potentially at stake. Statewide that number is much larger, given all the hospitals not in the network.

At this point, McCarthy is only asking to plead her case. Regardless of any deadline Anthem may argue, there is too much at stake to shut the door in her face.

Obviously, McCarthy’s goal is to keep her current health care providers, as promised by President Barack Obama and echoed by U.S. Sen. Jeanne Shaheen, D-N.H.

But beyond our urging that Anthem be required to negotiate with the excluded hospitals is the simple issue of fairness.

So far Sevigny has refused to release the data used by Anthem to justify its actions. Those actions not only excluded 10 hospitals, but essentially granted monopolies to in-network hospitals. By doing so, Anthem argues it was able to negotiate lower prices with those welcomed into the network.

But we have to ask, at what price?

Should Anthem’s plan stand, thousands of Granite Staters will be forced to drop their current doctors and hospitals. Some will travel not the fewer miles between Rochester and Dover’s Wentworth-Douglass Hospital, but the much longer distances it takes to reach network providers in the northern and western tiers of the state.

Then there are the financial consequences for hospitals such as Frisbie, which sees 10 percent of its client base at risk. Financial troubles for Frisbie would threaten the lives of those in and near the Lilac City.

Sevigny may have the technical ability to deny McCarthy a hearing. We are not privy to the information needed to pass that judgment.

What we can comment on is the need for fairness and openness.

The Insurance Commission is a public body charged with protecting the public good. That alone demands openness.

As for Anthem, we have to wonder if tarnishing the company name and fostering ill-will across the state is really a good business decision.